PHM Quality Improvement Collaboratives An Update

Collaborative #1 Co Chairs: Shannon Phillips, MD, MPH Paul Hain, MD Specific AIM: We will reduce the percent of patient ID band errors at hospitals in this collaborative by 50% by September 1, 2010.

Collaborative Colleagues Consulting Monroe Carell Jr. Children's Hospital at Vanderbilt TN Paul Hain, MD Collaborative 1. Cleveland Clinic Childrens Hospital OH Shannon Phillips, MD, MPH Meredith Lahl, RN, MSN, CNS 2. Denver Childrens Hospital CO Dan Hyman, MD Mariel Laire 3. New York Hospital Queens Laurie Gordon, MD 4. Our Lady of the Lake Regional Medical Center LA Steve Narang, MD Tracie Major, APRN, CNS, CPN 5. James Whitcomb Riley Childrens Hospital IN Michele Saysana, MD 6. Scottsdale Healthcare Hospitals AZ John Pope, MD 7. Morgan Stanley Childrens Hospital of NY Presbyterian Anu S ubramony, MD 8. Presbyterian Intercommunity Hospital CA Jeff Gill, MD

Results 18%6%

Change Concepts Raise awareness of safety risk for Staff Parents/Patients Shared educational materials Kinder, gentler ID bands

Collaborative #2 Co Chairs: Mark Shen, MD Julia Shelburne,MD Specific Aim: Over the next 6 months, we will lead a quality improvement collaborative and achieve measureable improvement in the frequency AND timeliness of communication of patient information to the PCPs at discharge with the Goal of 90% of hospitalist discharges at each participating hospital will have documentation of communication with a PCP within 2 calendar days of actual discharge.

Participants 1. Lora Bergert: Kapi`olani Medical Center, Honolulu 2. Michael Bryant: USC Keck School of Medicine 3. David Cooperberg: St. Christophers, Philadelphia 4. Dan Coughlin: Hasbro Childrens, Providence 5. Leah Mallory: Barbara Bush Childrens Hospital at Maine Medical Center,Portland 6. Beth Robbins: Anne Arundel Medical Center, Annapolis 7. Julia Shelburne: UT-Houston Medical School/Childrens Memorial Hermann Hospital 8. Mark Shen and Don Williams: Dell Childrens Medical Center, Austin 9. Ann Vanden Belt: St. Joseph Mercy Hospital, Ypsilanti, MI 10. Joyce Yang, Dan Hershey, and Erin Stucky: Rady Childrens Hospital, San Diego

Results Percent of discharges with documented communication with PCP within 2 calendar days of discharge, by month

Change Package Obtain support of hospital leadership Gather accurate contact information Automate the process using IT solutions Provide targeted and timely feedback to physicians Create incentives for attending physicians

Collaborative #3 Co Chairs: Matt Garber, MD Beth Robbins, MD Specific AIM: Reduce the use of inhaled short-acting bronchodilators in children hospitalized with bronchiolitis To reduce the number of bronchiolitis patients treated with any bronchodilator medication by 20% from that institutions baseline or to <=30% To reduce the average total number of treatments per patient by 50% from that institutions baseline

Participants Elizabeth L. Robbins, Anne Arundel Medical Center Jeanann P. Pardue MD, Director of CPG Inpatient Service East TN Children's Hospital Michele Lossius, MD, FAAP Assistant Professor, UF-COM Eric Balighian, Pediatric Hospitalist, St. Agnes Hospital John A Pope MD, MPH, Physician Director, Pediatric Services, Scottsdale Healthcare Hospitals Matthew Garber, MD,FAAP, FHM, Assistant Professor USC-SOM, Director Pediatric Hospitalists

% Bronchodilator Use: Preliminary Data Average of 25% decrease

% of Bronchodilator doses/pt: Prel Data Average of 47% Decrease

Change package A Respiratory Therapists Driven Protocol Communication at every level – nurse, RT, PCP, ED attendings, other hospitalists, learners - is needed to address cultural barriers New partnerships with RT, RN, IT, CQI, and administration are also needed to address technical barriers

Next Steps for PHM QI Collaboratives.. We have tested the concept PHM Physicians Can Collaborate to Improve Care Next Challenge Sustaining and Disseminating Finding a home for funding and infrastructure MOC for Pediatric Hospitalists ?